Usage of stavudine (D4T) - a retrospective analysis in a South London hospital

Effect of antiretroviral therapy use and adherence on the risk of hyperlipidemia among HIV-infected patients, in the highly active antiretroviral therapy era

HIV-infected patients exposed to antiretroviral therapy (ART) have an increased risk for hyperlipidemia and cardiovascular disease. We performed a longitudinal, comprehensive, and population-based study to investigate the cumulative effect of different types of ART regimens on hyperlipidemia risk in the Taiwanese HIV/ART cohort. A total of 13,370 HIV-infected patients (2,674 hyperlipidemia and 10,696 non-hyperlipidemia patients) were recruited after matching for age, gender, and the first diagnosis date of HIV infection by using the National Health Insurance Research Database in Taiwan. Hyperlipidemia risk associated with cumulative ART use, ART adherence, and their combination was assessed. The matched hyperlipidemia group had a larger number of patients using ART and a higher incidence of comorbidities, specifically, respiratory disease and diabetes. Patients with high ART dosage and dose-dependent manner adherence, respectively, demonstrated an increased risk of hyperlipidemia. For single ART regimens, patients receiving nucleoside reverse-transcriptase inhibitors (NRTI/NRTI)- containing regimen had the highest hyperlipidemia risk, followed by protease inhibitor (PI)- containing and non-NRTI- containing regimens. For combination ART regimens, patients receiving a NRTI/NRTI + PI regimen had the highest hyperlipidemia risk. An increased cumulative drug dose was observed in patients who received the PI, NRTI/NRTI, NRTI, and NNRTI regimens in the hyperlipidemia group, when compared to the non-hyperlipidemia group. In conclusion, ART cumulative use, adherence, and regimen may affect hyperlipidemia risk among HIV-infected patients in a dose-dependent manner.

Hyperalgesia induced by oral stavudine administration to rats does not depend on spinal neuronal cell death, or on spinal or systemic inflammatory cytokine secretion, or metabolic dysregulation

To investigate possible mechanisms of the hyperalgesia induced by the nucleoside reverse transcriptase inhibitor (NRTI) stavudine in rats, we examined neuronal death and inflammatory cytokine secretion in the spinal cord, and cytokine and lactate secretion in the plasma. Stavudine (50 mg kg(-1)) or placebo was administered orally to Sprague-Dawley rats once daily for three or six weeks. In one group, rats' responses to a blunt noxious mechanical stimulus applied to their tails were recorded before and at the end of the period of stavudine or placebo administration. Spinal cords excised from these rats after three and six weeks of stavudine or placebo administration were examined for neuronal necrosis and apoptosis. In a second group of rats, plasma and spinal cord samples collected after three and six weeks of placebo or stavudine administration were examined for changes in CINC-1, IL-6, adiponectin (plasma only) and lactate (plasma only) concentration. Daily stavudine administration induced mechanical hyperalgesia within three weeks, which was sustained until week six, but the hyperalgesia was not associated with neuronal apoptosis or necrosis, or elevated IL-6 concentrations in the spinal cord. The spinal cord concentration of CINC-1 increased, but only after six weeks of stavudine administration, when the hyperalgesia had been established for over three weeks. Stavudine administration did not affect the plasma concentration of IL-6, CINC-1, adiponectin or lactate. Thus, neither peripheral nor central inflammatory cytokine secretion, or neuronal death, or metabolic dysregulation contributed to the development of hyperalgesia in our model of stavudine-induced hyperalgesia in rats.